Atorvastatin in the Treatment of Dyslipidemic Patients with Very High Cardiovascular Risk and Nonalcoholic Fatty Liver Disease

Abstract

Nonalcoholic fatty liver disease (NAFLD) is defined as the presence of hepatic fat accumulation after ruling out other causes of hepatic steatosis. The aim of the study is to identify the role of statin therapy in dyslipidemic patients with very high cardiovascular risk and NAFLD in achieving low density lipoprotein (LDL) cholesterol targets while also evaluating the changes in liver enzymes levels. This prospective study included 140 patients with NAFLD, hyperlipidemia and elevated cardiovascular risk. Serum lipids were assessed and liver function tests were performed at baseline and at 6 months follow up in 10 mg/ 20 mg daily atorvastatin treatment schedule. The results showed that total cholesterol, LDL cholesterol and triglycerides were significantly reduced at 6 months follow-up, while high density lipoprotein (HDL) cholesterol has not undergone important changes. Statin treatment significantly improved alanine aminotransferase serum levels, whereas aspartate aminotransferase levels were not significantly reduced between baseline and follow-up. Although statin therapy appears to be safe and effective for use in patients with NAFLD, an insufficient treatment is commonly observed in clinical practice, in order to avoid liver damage . NAFLD is not only a major cause of liver related morbidity and mortality, but also an independent cardiovascular risk factor, with cardiovascular mortality being the most important cause of death. Therefore, detecting and modifying risk factors without impairing liver function is desirable.

Atorvastatin and Vitamin E Accelerates NASH Resolution by Dietary Intervention in a Preclinical Guinea Pig Model

“…Contrary to the PIVENS trial [33], treatment with atorvastatin and vitE alone did not improve ALT and AST. An improvement of AST and ALT was also reported for NAFLD patients receiving 20 mg atorvastatin for 12 weeks, with no additional effect by supplementing the statin with 400 IU vitE and 1000 mg vitC [32], whereas others have reported a reduction in ALT but not AST following six months of statin treatment (10–20 mg) in NAFLD patients [34]. The histological findings from the HF+ animals in the present study supports a state of hepatic stress, and show an increase NAS-score compared to LF and LF+ reaching significance at Week 28.…”

“…Although no therapy has yet been approved, vitE is recommended for NASH patients and is associated with improvements in histopathological lesions [31]. Alongside vitE supplementation, atorvastatin can be administered to target dyslipidemia in NASH patients and clinical studies have shown beneficial effects of statin treatment on dyslipidemia and markers of hepatic health in patients [32,33,34]. However, comparisons between studies are often challenging due to differences in, e.g., inclusion criterions and intervention time, dose and statin-type.…”